A friend was hospitalised with a serious illness recently. He was slipping in and out of coma and had to be kept in the intensive care unit for 10 days. Luckily, he manages to weather through this difficult time and now he is in rehabilitation. I was asked to provide some advice on the most appropriate diet during convalescence.

Start with rice porridge

There is no hard-and-fast rule. It really depends on the person’s condition. For my friend who was being tube-fed during his coma, the hospital advises soft food as he is still very weak and may have difficulty with swallowing. For Chinese, rice porridge which sweet potato is on top of the list for the sicks. It makes sense, since white rice is 90% carbohydrate, a perfect source of energy. Cooking sweet potato, which is high in dietary fibre, beta-carotene, vitamin C and B6, B5, B1-3, as well as a host of minerals, with rice into porridge is a perfect meal for breaking “fast” (See my previous post on sweet potato). It kicks start the digestive system and nourish the body.

Rice porridge should be the mainstay until the person is able to take solid food. Mix white rice with rice of other colours such as brown, red, black or other unrefined grains such as millet, quinoa, or buckwheat. These complex carbohydrates will provide more dietary fibre and nutrients beyond pure energy. However, make sure the porridge is thoroughly cooked to tender for ease of digestion. A crock pot slow cooker will be handy for such cooking (see my previous post on the benefits of slow cooking). For flavouring, it is best to use miso or fermented bean paste for added probiotics.

Make sure to add protein sources

To provide a balanced meal, one should add a variety of finely chopped vegetables, such as carrot, cauliflower, celery, coriander, mushroom, et cetera. For non-vegetarians, add a small amount of easily assimilated protein sources such as fish, chicken, or egg to allow the body to repair. For vegetarians, like my friend, the ideal protein sources are tofu and legumes like lentils, soy, peas, black beans, etc.

However, some may worry that the beans may be hard to digest by the patient and may cause bloating and stomach discomfort. This is a valid concern, since the outer layers of dried beans contain antinutrients which can prevent absorption. Therefore, it is important to thoroughly soak the beans before boiling. Research has shown that soaking for 12 hours and boiling for 80 minutes will greatly reduce the antinutrients in legumes (See my previous post on this topic). Hence, take time to prepare the beans.

A high-speed blender can be used to prepare bean and nut paste or drink that is both tasty and highly nutritious. Here is a sample recipe from a friend:

• 20 grams assorted beans (e.g. black, red, green, kidney, etc.) – Soaked (12 hours) and boiled (80 mins)
• 1 tablespoon – Cooked grains (brown rice, millet, quinoa, etc.)
• 3-4 Walnuts or Almonds
• 1-2 Seedless dates as sweeteners
• 1 teaspoon of chia seeds or flax seeds or sesame seeds
• 200ml warm water (can vary depending on the desirable thickness)
• Add all ingredients in a high-speed blender and blend for 60 seconds or until smooth.

Taking this as a dessert or a drink once or twice daily will greatly improve the nutritional values of one’s diet.

Things to avoid

In Chinese medicine, herbs such as dang shen (黨參), astragalus (北箕, 黄箕), or ginseng (人參) are tonic for replenishing the qi (气) of the body during recovery from illness. Chinese commonly make herbal soup with these ingredients to promote healing and recovery. However, many patients are still on a host of Western medications during their stay in hospital. It is not advisable for them to take herbal soup due to unknown herb-drug interactions. Hence, it will be prudent to only serve them herbal soup after discharge from hospital and the medications have been reduced.

Although I normally advise eating more fruits and raw vegetables as part of a healthy diet, this is not the case for convalescence. From the Chinese medicine perspective, fruits and raw vegetables can be too “cooling” for the body and not suitable for patients who are recovering from illnesses. Furthermore, uncooked food come with more bacteria which the patients’ depleted immunity may not be able to handle. Hence, a small serving of soft pear or papaya one or twice a day should be fine, but not more. Restrict fruit juice to only a small glass a day.

As for drinks, it depends on the condition of the patients. Plain water is generally advisable; however, the amount may be subject to restriction due to poor kidney function. Coffee, tea, soft drinks, alcohols, sugar, is out of the question. Also, food that is stimulating or placing demands on the body, including hot spices (e.g. curry and chillies), red meat, seafood, fried food, saturated fats, et cetera should not be served.

To prevent digestive issues, especially among older adults, milk and excessive gluten-based food (e.g. bread, cake, noodles, etc.)  should also be avoided. Although hospital dietitians may recommend formulated nutritional drinks, I suggest serving home-made drinks from soy, black beans, apricot kernels, et cetera instead. (See my previous post on the recipe of “Chines almond milk”)

Key supplements to consider

Patients normally are put on antibiotics as a treatment for infections during their hospital stay. Antibiotics destroy bad bacteria but also cause collateral damage to the good bacteria. It is important to replenish and rebuild the gut microflora in the body. Probiotics can be supply through cultured food such as yoghurt, kefir, miso, et cetera. It will also be good to start supplementing with probiotics in powder form as soon as the patients can start swallowing soft meal. It goes a long way to improve the digestive system, enhance immunity, and speed up recovery (See my previous post on the benefits of probitotics).

I will also recommend spirulina powder as a food supplement for extra protein and nutrients. It can be sprinkled on the food like porridge or mix in drinks. However, spirulina has a distinct smell and taste that is not palatable for many. Alternatively, a super green powder formula that blends many types of green vegetables can be used. Such blend normally contains the nutrients of many greens (e.g. barley green, wheat green, broccoli, asparagus, kale etc.) that may not be easily obtained through diet by a patient in hospital bed. (See my previous post on the benefits of greens)

Summary

In summary, during convalescence, the diet should be nourishing, not stimulating or placing demands on the body.  A soft diet with grains, vegetables, beans, and lean protein sources is the ideal and it should be supplemented with probiotics and some extra greens. Avoid milk, red meat, seafood, and spices which are stimulants. It will take time for the body to recover. Recovery will be faster if the body gets the right nourishment.